Veterinary Surgery最新文献

Objective: To evaluate the rate of residual polystomatic sublingual acinar tissue if tunneling dorsal to the digastricus muscle and dissection to the sublingual caruncle is not performed during mandibular-sublingual sialadenectomy in cats.

Study design: Cadaveric study.

Sample population: A total of 10 feline cadavers.

Methods: Mandibular-sublingual sialadenectomy was performed bilaterally in 10 feline cadavers using a ventral or ventrolateral approach in a randomized fashion. Salivary ducts were dissected as far rostral as possible with retraction of the masseter and digastricus muscles until they traveled dorsal to the digastricus muscle, where a ligature was applied. The position of the lingual nerve was identified. Following tunneling, dissection continued rostrally to the sublingual oral mucosa, where ducts were excised. Histology of dissected tissue rostral to the ligature was performed.

Results: Histology identified evidence of salivary acinar tissue in 13/19 (68.4%) specimens - 7/10 (70.0%) of specimens obtained with the ventral approach and 6/9 (66.7%) of those obtained with the ventrolateral approach (p > .99). In all cases, the lingual nerve was identified with retraction of the masseter and digastricus muscles without tunneling.

Conclusion: Tunneling dorsal to the digastricus muscle exposed additional polystomatic salivary acinar tissue in most cases.

Clinical significance: Tunneling dorsal to the digastricus via a ventral or ventrolateral approach may decrease the rate of polystomatic sublingual acinar tissue being left in situ in clinical cases.

Objective: To determine the prevalence of popliteal sesamoid displacement (PSD) in dogs with cranial cruciate ligament disease (CCLD) on radiographs, assess its reduction following tibial plateau leveling osteotomy (TPLO), and evaluate cranial tibial subluxation (CTS) pre- and postoperatively.

Study design: Retrospective radiographic observational study.

Sample population: A total of 163 client-owned dogs diagnosed with CCLD and treated with TPLO.

Methods: Pre- and postoperative 90° flexion radiographs were reviewed to assess CTS, tibial plateau angle (TPA), stifle opening angle, PSD, and osteotomy localization. Statistical analyses evaluated associations between PSD, CTS, TPA, and osteotomy location.

Results: A PSD was observed in 14.4% of cases preoperatively and was associated with significantly higher CTS. Popliteal sesamoid reduction was achieved in 100% of cases post-TPLO. The CTS persisted postoperatively in all dogs with preoperative subluxation (N = 82; 50.3%), though at significantly reduced levels. Osteotomy positioning did not significantly affect postoperative CTS. Postoperative TPA showed a weak negative correlation with residual CTS.

Conclusion: A PSD is an infrequent finding, typically associated with more pronounced preoperative CTS. This displacement reliably resolves after TPLO when CTS was minimal. Although postoperative CTS was frequently observed, it was generally mild and not significantly affected by the osteotomy location.

Clinical significance: The PSD occurs infrequently after CCLD but is associated with increased CTS. Popliteal sesamoid reduction was associated postoperatively with minimal CTS and appropriate TPA. Radiographic assessment of popliteal sesamoid reduction may provide an additional, objective parameter for detecting any residual cranio-caudal instability following TPLO.

Objective: To determine whether radiographic templating of femoral stem size for total hip arthroplasty (THA) using extended and flexed hip radiographs are interchangeable.

Study design: Retrospective radiographic study.

Sample population: A total of 25 dogs evaluated as THA candidates.

Methods: Hip-extended and hip-flexed radiographs were templated for femoral stem implant size by three surgeons. A fourth investigator measured femoral length, canal flare index (CFI), and osteoarthritis scores for each projection and recorded implant size from surgical records. Templated stem sizes from each projection were compared with the implanted stem sizes using Bland-Altman analysis. Descriptive statistics were reported based on data distribution.

Results: Templated femoral stem size differed between surgeons (p = .014); the median (IQR) stem size was #9 (8-10) for one surgeon, compared to #8 (7-9) for the other surgeons. Templated stem sizes on extended and flexed radiographs were #8 (7-9) and #9 (7-9), respectively (p < .0001). The mean (SD) CFI in extended and flexed projections were 1.61 (0.21) and 1.89 (0.30), respectively (p < .0001). Implant size was underestimated using the extended projection (mean difference: -0.54) and overestimated using the flexed projection (mean difference: 0.30). Positive proportional bias was present between the extended and flexed projections (slopes: 0.22 and 0.25; p < .003).

Conclusion: Neither templating method consistently predicted the clinical femoral stem implant size.

Clinical significance: Hip-flexed templating may serve as a practical alternative when extended projections are not possible, though intraoperative assessment remains essential for final implant selection, particularly since measurement bias increased for stems larger than size 9.

Objective: To determine the accuracy and safety of two established landmark-based techniques and two novel techniques for stifle arthrocentesis in dogs.

Study design: Ex vivo prospective study.

Animals: A total of 32 paired canine cadaver pelvic limbs.

Methods: An electronic survey assessed technique prevalence among surgeons. Pelvic limbs (n = 32) were randomized to one of four techniques; lateral intercondylar notch (LINC), infrapatellar (INFRA), suprapatellar (SUPRA), or proximal lateral parapatellar pouch (POUCH) technique, with n = 8 per group. Repositions, attempts, and synovial fluid presence were recorded. Stifle arthrography assessed accuracy. India ink assay assessed iatrogenic articular cartilage injury (IACI). Omnibus tests were used (p < .05), with post hoc Bonferroni-correction (p < .0083).

Results: A total of 40 surgeons responded, with LINC most commonly used (35/40, 87.5%). All tested techniques were accurate (8/8, 100%, p > .9). INFRA and SUPRA required more needle repositions (median 3 and 2, respectively) than LINC and POUCH (median 1 for both), (p = .001). LINC and SUPRA produced no IACI, INFRA (6/8, 75%) and POUCH (3/8, 37.5%) (p = .007). Over half of IACI produced with INFRA exceeded 10 mm² in area, all on weightbearing cartilage (p = .041). POUCH injuries occurred exclusively on non-weightbearing cartilage (p = .041).

Conclusion: LINC and INFRA are currently used clinically and were accurate; however, INFRA required increased repositions and had high IACI rates on weightbearing cartilage. Two novel techniques were feasible and accurate; SUPRA was safe with no IACI, while POUCH had high IACI risk on non-weightbearing cartilage.

Clinical significance: SUPRA may be a safer alternative than current established techniques and warrants further clinical investigation. INFRA carries high IACI rates.

Objective: To report the outcomes of titanium mesh (TM) cranioplasty without polymethylmethacrylate (PMMA), incorporating a deliberate gap between the foramen magnum decompression (FMD) surface and the TM, in small-breed dogs with Chiari-like malformation and syringomyelia (CM/SM).

Study design: Retrospective clinical study.

Animals: A total of 87 client-owned small-breed dogs diagnosed with CM/SM by magnetic resonance imaging, all presenting with neurologic deficits.

Methods: All dogs underwent modified FMD. A gap was preserved between the FMD surface and the TM to facilitate tissue integration and reduce postoperative compressive forces. Clinical status was assessed based on neurologic improvement, medication dependency, and need for revision surgery.

Results: Surgical decompression with the modified TM technique resulted in sustained clinical improvement in most dogs. A total of 76 dogs (87%, 76/87) showed long-term improvement, and no revision surgeries were required during a median follow-up of 35 months (range: 27-73 months). Follow-up evaluation comprised postoperative computed tomography (CT) imaging at 6 months, as well as structured telephone interviews with owners to monitor clinical status. Only a small subset of dogs (13%, 11/87) required continued medication after surgery due to recurrence of signs.

Conclusion: Retrospective analysis showed that the modified TM technique, using a deliberate gap, was safe and effective in small-breed dogs with CM/SM, successfully preserving the decompression space and maintaining long-term neurologic stability.

Clinical relevance: The modified TM technique approach achieves durable neurologic improvement and minimizes long-term complications in small-breed dogs, demonstrating practical utility in managing this clinically challenging population.

Objective: To compare implant failure and gap displacement characteristics of simulated medial mid-body proximal sesamoid bone (PSB) fractures repaired with bone-screw-fasteners (BSF) or cortical screws (CS) in single or double screw configurations.

Study design: Ex vivo experimental study.

Sample population: A total of 14 paired equine cadaver forelimbs.

Methods: Medial mid-body PSB osteotomies were created in each forelimb. Surgical repair was performed using either: (1) single 3.5 mm BSF (BSF_single), (2) single 4.5 mm CS (CS_single), (3) two 3.5 mm BSFs (BSF_double), or (4) two 3.5 mm cortical screws (CS_double) (n = 7 repairs/group). Biomechanical properties and failure characteristics were evaluated through a single cycle to failure. Comparisons between groups were made using Wilcoxon-matched pairs or Mann-Whitney tests. Statistical significance was p < .05.

Results: The BSF_double group (2081 ± 181 N) had significantly higher yield than BSF_single (1458 ± 92 N, p = .01) and CS_single (1532 ± 86 N, p = .02) groups. The CS_double group (2101 ± 126 N) had significantly higher yield than BSF_single (p = .001) and CS_single (p = .003) groups. Biomechanical properties were not different between BSF_single and CS_single groups, or between BSF_double and CS_double groups. Gap measurements at construct failure were significantly higher abaxially than axially in all groups (all p < .05).

Conclusion: No differences were detected between the single BSF and 4.5 mm CS for repair of medial mid-body PSB fractures. Surgical repair using two screws has biomechanical advantage to single screw repair, regardless of screw type ex vivo.

Clinical significance: The BSF is not different to CS for repair of PSB fractures. Counteracting abaxial forces in surgical repair of mid-body PSB fractures warrants further investigation.

Objective: To evaluate postoperative racing performance of a population of Standardbred racehorses following arthroscopic removal of an osteochondrosis dissecans (OCD) lesion of the femoropatellar joint.

Study design: Retrospective study.

Sample population: A total of 45 client-owned Standardbred racehorses.

Methods: OCD lesions were measured and graded using the length of the subchondral bone defect from preoperative radiographs. Postoperative racing results were obtained from the United States Trotting Association, and follow-up owner surveys were conducted. A control group of contemporaneous paternal siblings free of OCD lesions was selected for comparison of racing performance. Regression analysis was used to determine associations between presence or grade of OCD lesions and performance parameters with sex and gait covariates.

Results: There was no significant difference in proportion of horses starting a race based on OCD lesion grade. Affected racehorses had fewer starts at 3 years of age (IRR = 0.84 [95% CI: 0.74-0.96], p = .012) but not at 2 years of age, when compared to unaffected siblings. There was also no difference in race wins or earnings between affected and unaffected horses.

Conclusion: Arthroscopy remains an effective treatment for OCD lesions of the femoropatellar joint in Standardbred racehorses, when performed prior to the start of intensive training, and lesions treated in this manner have no major impact on racing potential. Limitations included a small number of affected individuals especially with higher grades of OCD lesions and there was no conservative treatment group.

Clinical significance: OCD lesions within the femoropatellar joint in Standardbred racehorses resulted in minimal impact on postoperative racing performance when removed arthroscopically.

Objective: To report perioperative morbidity and mortality in dogs and cats undergoing total lung lobectomy using a hilar circumferential ligature (HCL).

Study design: Retrospective clinical study.

Sample population: Client owned dogs (n = 65) and cats (n = 15).

Methods: Medical records were searched for dogs and cats undergoing surgery for total lung lobectomy using a HCL, consisting of either a commercial pre-tied ligature loop (CPLL) or handtied circumferential ligature (HTCL). Cases were collected between 2017 and 2022 from six different hospitals and included signalment and perioperative data.

Results: A total of 94 lung lobes were removed, 59 with CPLL and 35 with HTCL, in 80 dogs and cats. The HTCL group comprised seven sliding, 25 modified Miller's and three Roeder knots. Intraoperative hemorrhage occurred in 4/94 (4.3%) lung lobectomies using 2/59 (3.4%) CPLL and 2/7 (28.6%) sliding knots. There was no association between hemorrhage and use of CPLL versus HTCL (p > .99), knot type (p = .09), or number of sutures per pedicle (p = .30). One dog died intraoperatively from tumor extrusion into the bronchus. One dog required revision surgery for pneumothorax eight days postoperatively.

Conclusion: The overall incidence of intraoperative complications was low. Our findings support the use of CPPLs, handtied Roeder and modified Miller's knots for total lung lobectomy in dogs and cats with clinical disease. Sliding knots should be used with caution.

Clinical significance: The low complication rate, together with the ease of use and cost efficiency of HCL, makes this technique a promising option for total lung lobectomy.

Objective: To describe a modified two-portal tenoscopic technique for proximal manica flexoria (MF) resection designed to preserve the mesotendons (MTs) of the deep digital flexor tendon (DDFT).

Study design: Prospective clinical study.

Animals: Client-owned horses (n = 30).

Methods: MF resection was performed in four steps: (1) Transection of the lateral attachment of the MF to the superficial digital flexor tendon (SDFT), staying abaxial to the lateral MT; (2) transection of the medial attachment of the MF to the SDFT between the flexor tendons from distal to proximal until reaching the level of the medial MT; (3) transection of the proximal medial attachment of the MF to the SDFT dorsal to the DDFT; and (4) fixation with a Kocher-Ochsner clamp, followed by rotation to disrupt the areolar tissue and extract the MF. Long-term follow-up (>6 months) was assessed by telephone interview.

Results: Proximal MF tears were located medially in 20/30 (66.7%), laterally in 7/30 (23.3%), and both medially and laterally in 3/30 (10.0%) cases. Hindlimbs were affected in 27/30 (90.0%), and forelimbs in 3/30 (10.0%). Nine of 11 sport horses (81.8%) and 12 of 17 leisure horses (70.6%) returned to the same or a higher level of work.

Conclusion: The MF was successfully resected in all horses irrespective of tear localization.

Clinical significance: This two-portal MF resection technique, described step by step, was developed to further limit surgical trauma with a specific focus on preserving the MTs and thereby maintaining the extrinsic blood supply to the flexor tendons.